title: Salvage radiation therapy improves metastasis-free survival for clinically aggressive and indolent prostate cancer recurrences after radical prostatectomy.
abstract: OBJECTIVE
  To describe 5- and 10-year rates of metastasis-free survival (MFS) stratified by Gleason score (GS) and prostate-specific antigen doubling time (PSADT) for patients receiving salvage radiation therapy (SRT) after biochemical recurrence (BR) postradical prostatectomy (RP).
  
  
  METHODS
  A total of 236 patients who underwent SRT without receiving concomitant androgen deprivation therapy at a single institution after BR post-RP were retrospectively reviewed. The Kaplan-Meier methods and log-rank analysis were used to determine the MFS rates.
  
  
  RESULTS
  Median follow-up post-SRT was 7.1 years. As of last follow-up, 59 men (25%) had developed metastasis. On univariate analysis, both GS and PSADT predicted MFS (P<0.001). Five- and 10-year rates of MFS were calculated for patients with GS 2 to 6, 7, and 8 to 10 and for patients with PSADT < 3, 3 to 9, 9 to 15, and >15 months, who received no additional salvage therapy until the development of metastases. The 5- and 10-year MFS for GS 8 to 10 were 62% and 50%, respectively, compared with 94% at both 5 and 10 years for GS 2 to 6. The 5- and 10-year MFS for PSADT < 3 months were 70% and 61%, respectively, compared with 100% and 90% at 5 and 10 years, respectively, for PSADT >15 months.
  
  
  CONCLUSIONS
  After BR post-RP, SRT results in low 5- and 10-year rates of metastasis after initial BR. Importantly, a substantial proportion of patients with high-risk disease (GS 8 to 10 or PSADT < 3 mo) are free from metastasis at these same time points. Therefore, SRT should not be withheld from patients based solely on the presence of adverse disease risk factors.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors.forename: William C
authors.initials: WC
authors.lastname: Jackson
authors.forename: Skyler B
authors.initials: SB
authors.lastname: Johnson
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hamstra
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen